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Bariatric Surgery Outcomes in Patients with Previous Organ Transplant: Scoping Review and Analysis of the MBSAQIP

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Abstract

Background

Obesity is a major risk factor for transplant. Laparoscopic bariatric surgery (LBS) offers transplant patient benefits including improved comorbidities, graft function, and longevity. We completed a scoping review and analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to determine the risk-benefit profile of LBS after transplant. We also compared laparoscopic sleeve gastrectomy (LSG) to laparoscopic Roux-en-Y gastric bypass (LRYGB) following transplant.

Methods

Univariate analysis determined between group differences with subgroup analysis comparing LSG versus LRYGB in transplant patients. Multivariable analysis assessed whether prior transplant was independently associated with major complications or mortality.

Results

A total of 469 (0.1%) patients had previous transplant and had more comorbidities and more often underwent LSG. Operative time (93.9 min vs 83 min, p < 0.001) and length of stay were longer. Major complications were threefold higher in patients with a transplant history (9.6% vs 3.2%; p < 0.001. Previous transplant was the second greatest independent predictor for major complication (OR 2.14 [1.54–2.98], p = < 0.001) but was not predictive of death (OR 1.06 [0.14–8.13] p = 0.956).

Amongst transplant patients, LRYGB demonstrated higher rates of leak (n = 1), VTE, AKI, unplanned intubation, and readmission.

Conclusions

The 30-day complication rate from LBS is three times higher amongst patients with a transplant. LSG is likely the best surgical approach. Despite risks, post-transplant patients incur important benefits from LBS. Surgeons must be aware of this risk-benefit profile when determining LBS candidacy.

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Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, Alberta, Canada

    Kevin Verhoeff, Jerry T. Dang, Aryan Modasi & Noah Switzer

  2. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada

    Daniel W. Birch & Shahzeer Karmali

Authors
  1. Kevin Verhoeff
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  2. Jerry T. Dang
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  4. Noah Switzer
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Corresponding author

Correspondence to Jerry T. Dang.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Informed consent does not apply.

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Appendix

Appendix

Data collection definitions

Leak—defined by any of the following: reoperation for anastomotic/staple line leak, readmission for anastomotic/staple line leak, reintervention for anastomotic/staple line leak, drain present 30 days postoperatively, or death caused by anastomotic/staple line leak.

Postoperative VTE—defined by any of the following: reoperation for pulmonary embolism or venous thrombosis, readmission for pulmonary embolism or venous thrombosis, reintervention for pulmonary embolism or venous thrombosis, venous thrombosis requiring anticoagulation therapy, pulmonary embolism requiring anticoagulation therapy, and does not include anticoagulation for presumed/suspected VTE.

Postoperative bleed—defined by any of the following: reoperation for bleed, readmission for bleed, reintervention for bleed, transfusion required in first 72 h of surgery start time, and death caused by bleeding.

Major complication—defined by any of the following: cardiac complications, pneumonia, acute renal failure, reoperation, reintervention, venous thromboembolism, deep surgical site infection, wound disruption, sepsis, unplanned intubation, leak, bleed, coma > 24 h, and cerebral vascular accident.

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Verhoeff, K., Dang, J.T., Modasi, A. et al. Bariatric Surgery Outcomes in Patients with Previous Organ Transplant: Scoping Review and Analysis of the MBSAQIP. OBES SURG 31, 508–516 (2021). https://doi.org/10.1007/s11695-020-05042-w

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  • DOI: https://doi.org/10.1007/s11695-020-05042-w

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